CareSource Health Substance Abuse Treatment Coverage (2026)

Understanding CareSource Coverage for Substance Abuse Treatment

CareSource is a nonprofit health insurance organization serving over 2 million members across multiple states with government-sponsored plans that include coverage for mental health and substance use disorder treatment. Founded in 1989, CareSource is the largest Medicaid plan in Ohio and the second-largest Medicaid plan in the United States.

Quick Facts About CareSource Coverage:

• Plans Available: Medicaid, Marketplace (Bronze, Silver, Gold tiers), and Dual Medicare/Medicaid plans
• States Served: Arkansas, Georgia, Indiana, Kentucky, North Carolina, Ohio, and West Virginia
• Coverage Mandate: All plans comply with the Affordable Care Act (ACA), requiring coverage for mental health and substance use disorder services as essential health benefits
• Treatment Types Covered: Medical detox, inpatient rehab, outpatient programs (PHP/IOP), medication-assisted treatment, and co-occurring disorder care
• Cost Structure: Varies by plan tier – Bronze covers 60%, Silver covers 70%, Gold covers 80% of care costs
• Network Requirements: Most plans require in-network providers for optimal coverage

If you’re struggling with substance use disorder and have CareSource insurance, you likely have coverage for addiction treatment. The extent of that coverage depends on your specific plan type, state, and the medical necessity of the treatment.

Need help navigating your benefits right now? Call our 24/7 confidential helpline at (844) 491-5566 to speak with a treatment advisor who can verify your CareSource coverage for free and help you find appropriate care.

The Affordable Care Act changed the landscape of addiction treatment by requiring most insurance plans to cover mental health and substance use disorder services. This means CareSource members have access to a range of treatment options – from medical detoxification to long-term outpatient therapy. However, understanding what your specific plan covers, finding in-network providers, and navigating pre-authorization requirements can feel overwhelming when you’re already dealing with addiction.

At Sober Steps, we specialize in helping individuals understand and maximize their insurance benefits, including CareSource plans, to access the addiction treatment they need without unnecessary barriers. Our mission is to provide confidential support and resources to guide you through every step of the recovery process.

This guide will walk you through exactly what CareSource covers for substance abuse treatment, how to verify your benefits, and the steps to enroll in appropriate care based on your specific plan and needs.

What is CareSource and What Does It Cover?

CareSource is a truly unique organization in the healthcare landscape. Founded in 1989 as a nonprofit, its original mission was to provide access to quality healthcare for vulnerable populations. From its humble beginnings, it has grown into a major player, now serving over 2 million members across seven states. This growth is a testament to its commitment to accessible care. With an annual revenue of $13.1 billion and a dedicated team of 4,500 employees, CareSource has significantly expanded its reach and impact. In fact, it has solidified its position as the largest Medicaid plan in Ohio and the second largest in the entire United States.

At its core, CareSource offers government-sponsored health plans. This means they often work in partnership with state and federal programs to deliver healthcare solutions. Their product offerings have evolved significantly since their founding to meet diverse needs. Today, they provide a range of plans, including:

• Medicaid Plans: These are designed for individuals and families with limited income and resources, offering comprehensive benefits often at little to no cost. CareSource provides Medicaid plans in states like Ohio, Indiana, and Georgia.
• Marketplace Plans: Available through the Affordable Care Act (ACA) marketplace, these plans offer various levels of coverage (Bronze, Silver, Gold tiers) for individuals and families who may not qualify for Medicaid but need affordable health insurance. CareSource offers Marketplace plans in states such as Kentucky, West Virginia, and North Carolina.
• Dual Plans: Specifically for individuals who qualify for both Medicare and Medicaid, these plans help coordinate benefits to ensure seamless care.
• Special Needs Plans: Custom for specific populations, such as those with chronic conditions or requiring long-term care.
• Care Coordination Plans: These plans focus on holistic support, especially for individuals with complex health needs, as seen in their partnerships in Arkansas.

The services CareSource offers are broad, encompassing everything from primary care and preventive services to specialized treatments. Critically for us, this includes extensive coverage for mental health and substance use disorder services, largely mandated by the Affordable Care Act. This commitment to comprehensive care is a cornerstone of their approach. For more detailed information about their history and mission, you can visit their official About us CareSource page.

Understanding Your CareSource Plan Tiers

When you’re looking at CareSource Marketplace plans, you’ll often encounter different “metal tiers”: Bronze, Silver, and Gold. Think of these tiers as different ways to share the cost of your healthcare with CareSource. They don’t necessarily indicate the quality of care, but rather how much you pay for your monthly premium versus how much you pay when you receive services.

• Bronze Plans: These plans typically have the lowest monthly premiums but the highest costs when you get care. They cover 60% of care costs, meaning you’re responsible for the remaining 40% through deductibles, copays, and coinsurance until you reach your out-of-pocket maximum. If you don’t expect to use many medical services, a Bronze plan might seem appealing due to lower monthly payments, but be prepared for higher costs if you do need significant treatment, such as for substance use disorder.
• Silver Plans: These plans strike a balance between monthly premiums and out-of-pocket costs. They cover 70% of care costs, leaving you responsible for 30%. Silver plans are often a popular choice because they offer a good middle ground, and for those who qualify, they may also come with cost-sharing reductions, which can significantly lower your deductibles, copays, and out-of-pocket maximums.
• Gold Plans: These plans have higher monthly premiums but lower costs when you get care, covering 80% of care costs (you pay 20%). If you anticipate needing a lot of medical services, including addiction treatment, a Gold plan might save you money in the long run because your out-of-pocket expenses per service will be lower.

Understanding these tiers, along with terms like copays (a fixed amount you pay for a service), deductibles (the amount you must pay before your insurance starts to pay), and out-of-pocket maximums (the most you’ll have to pay in a year), is crucial. For some CareSource Medicaid plans, particularly in states like Ohio, treatment for addiction may even come with $0 cost, making it incredibly accessible.

The Role of the Affordable Care Act (ACA)

The Affordable Care Act (ACA), signed into law in 2010, fundamentally changed how health insurance providers, including CareSource, approach coverage for mental health and substance use disorder services. Before the ACA, many insurance plans either didn’t cover these services at all or offered very limited coverage. The ACA mandated that most individual and small employer health insurance plans cover 10 “essential health benefits” (EHBs), and crucially, mental health and substance use disorder services are among them.

This means that any CareSource plan you enroll in, whether it’s a Marketplace plan, Medicaid, or a Dual plan, will include at least some coverage for addiction treatment and mental health support. This is a huge win for individuals and families struggling with these issues, as it removes a significant financial barrier to seeking help.

Furthermore, the ACA strengthened parity laws. This means that mental health and substance use disorder benefits must be offered at a level comparable to medical and surgical benefits. For example, if your plan doesn’t require pre-authorization for a physical health emergency, it generally shouldn’t require it for a mental health or substance use disorder emergency either. This ensures that treatment for addiction is treated with the same importance as any other medical condition. The ACA also prohibits insurance companies from denying coverage or charging more based on pre-existing conditions, which is particularly vital for those with ongoing substance use disorders. You can learn more about mental health and substance abuse coverage under the ACA on HealthCare.gov.

Types of Addiction Treatment Covered by CareSource Insurance

One of the most important aspects of CareSource coverage is its commitment to helping members access a full spectrum of addiction treatment services. We know that recovery isn’t a one-size-fits-all journey, and different individuals require different levels and types of care. CareSource plans, guided by the ACA’s mandates, typically cover a range of treatments, provided they are deemed medically necessary and part of an individualized treatment plan developed by a healthcare professional.

This continuum of care ensures that from the initial crisis to long-term recovery support, members have options.

Medical Detoxification

Often the first critical step in overcoming substance dependence, medical detoxification is designed to safely manage the physical symptoms of withdrawal. This process can be uncomfortable, painful, and even dangerous if not medically supervised. CareSource typically covers medical detox services, recognizing their essential role in preparing an individual for further treatment.

During medical detox, you’ll receive 24/7 medical supervision and support. Healthcare professionals monitor vital signs, administer medications to alleviate withdrawal symptoms, and ensure your safety and comfort. While the average length of stay for detox is often less than 10 days, it provides a crucial foundation for recovery, allowing your body to stabilize and your mind to begin focusing on therapeutic work. For immediate help with detox, call our confidential helpline at (844) 491-5566. You can also dig into more research on detoxification and substance abuse treatment via the SAMHSA guide, Detoxification and Substance Abuse Treatment.

Inpatient and Residential Rehab

For many struggling with severe substance use disorder, inpatient or residential rehabilitation offers the most immersive and supportive environment for initial recovery. These programs provide a structured setting where individuals live at the facility for an extended period, typically from 30 to 90 days, or sometimes longer.

Within these programs, CareSource coverage generally extends to:

• 24/7 Support and Supervision: A safe, distraction-free environment removes individuals from triggers and provides constant professional care.
• Individual Therapy: One-on-one sessions with a therapist to address underlying issues, develop coping mechanisms, and create personalized recovery plans.
• Group Counseling: Peer support and shared experiences are powerful tools for healing and developing social skills crucial for recovery.
• Holistic Therapies: Many programs integrate activities like yoga, meditation, art therapy, and nutritional counseling to promote overall well-being.
• Medical Management: For any co-occurring physical or mental health conditions.

Inpatient rehab is often recommended for those with a long history of substance abuse, co-occurring mental health disorders, or those who have not found success with less intensive forms of treatment.

Outpatient Program Levels (PHP & IOP)

For individuals who require a high level of care but have stable living situations and a strong support system, or who are transitioning from inpatient treatment, CareSource covers various outpatient program levels. These programs allow you to live at home or in sober living while attending therapy and treatment sessions during the day.

• Partial Hospitalization Programs (PHP): Often referred to as “day treatment,” PHPs provide comprehensive care similar to inpatient programs but without the overnight stay. A typical PHP might involve 4-8 hours of treatment per day, 3-5 days a week, for 3-4 weeks, totaling at least 20 hours per week. This intensive schedule allows for significant therapeutic work while offering the flexibility to return home each evening.
• Intensive Outpatient Programs (IOP): IOPs offer a step down in intensity from PHP, providing a more flexible schedule while still delivering structured therapeutic support. IOPs typically involve 9-20 hours of treatment activities per week, spread across 3-5 days. A common recommendation is for a 90-day duration. This allows individuals to manage work, school, or family responsibilities while actively engaging in their recovery.

The benefits of outpatient care, covered by CareSource, include:

• Flexibility: Allows individuals to maintain daily responsibilities like work or family care.
• Real-World Application: Provides opportunities to practice coping skills in everyday situations.
• Strong Support System: Encourages continued engagement with family and community support.
• Cost-Effectiveness: Often less expensive than inpatient care, making it a viable option for many.

Beyond PHP and IOP, CareSource also covers general outpatient care, which involves less frequent sessions, often once or twice a week, focusing on therapy, relapse prevention, and connecting with community resources. Telehealth options for remote treatment may also be available, depending on your plan and state.

Co-Occurring Disorder Treatment

It’s very common for individuals struggling with substance use disorder to also have a co-occurring mental health condition, such as depression, anxiety, or PTSD. This is often referred to as a “dual diagnosis.” Addressing both conditions simultaneously is crucial for successful, long-term recovery.

CareSource recognizes the importance of integrated care for co-occurring disorders. Their plans, in line with ACA mandates, typically cover specialized treatment that addresses both the mental health condition and the substance use disorder concurrently. This approach ensures that treatment for one condition doesn’t inadvertently exacerbate the other.

Integrated treatment for co-occurring disorders may include:

• Psychiatric Evaluation and Medication Management: To stabilize mental health symptoms.
• Therapy (Individual and Group): Utilizing techniques like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) custom to dual diagnosis.
• Trauma-Informed Care: Addressing past traumas that often contribute to both conditions.
• Life Skills Training: Developing healthy coping mechanisms and relapse prevention strategies.

We understand that navigating these complex needs can be challenging, but rest assured, if you have a CareSource plan, you likely have access to the comprehensive care needed for both your mental health and substance use disorder. For more in-depth information on co-occurring disorders, refer to Information on co-occurring disorders.

How to Verify and Use Your CareSource Plan for Rehab

Understanding that you have CareSource coverage for addiction treatment is one thing; navigating the actual process of using it is another. It can seem daunting, but we’re here to break it down into manageable steps. Key considerations will be pre-authorization requirements and whether a facility is in-network or out-of-network.

Step 1: Contact CareSource or a Treatment Advisor

The very first step is to get a clear picture of your specific benefits. The best way to do this is to directly contact CareSource.

• Call the number on your insurance card: This is usually the member services line, and representatives can provide detailed information about your plan’s coverage for substance use disorder treatment, including any deductibles, copays, or pre-authorization requirements. Make sure to have your member ID ready.
• Use the online member portal: Many CareSource plans offer an online portal where you can review your benefits, check claims, and sometimes even find in-network providers.
• Call a confidential treatment advisor at (844) 491-5566: We offer a free, no-obligation verification of your CareSource benefits. Our advisors are experts at understanding insurance policies and can quickly tell you what your plan covers, helping to remove the guesswork and stress from the process. This service is designed to connect you with care as smoothly as possible.

The more specific information you have about your plan, the better.

Step 2: Finding In-Network Rehabs with CareSource

Once you know what your CareSource plan covers, the next crucial step is finding a treatment facility that accepts your insurance and is “in-network.”

• Use the CareSource provider directory: CareSource maintains an online directory of healthcare providers and facilities that are part of their network. Using this tool is the most direct way to find in-network rehabs. Choosing an in-network provider almost always results in lower out-of-pocket costs because CareSource has negotiated rates with these facilities.
• Ask facilities directly: When you contact potential treatment centers, always ask upfront if they accept CareSource and if they are in-network for your specific plan. They often have staff dedicated to insurance verification who can help.
• Medical Referral: In some cases, particularly for certain levels of care or specialized treatments, your CareSource plan may require a referral from your primary care physician or a medical professional to ensure the treatment is medically necessary. This is a common practice to ensure appropriate care and manage costs.

While CareSource plans generally prefer in-network care, out-of-network coverage might be available, but it typically comes with significantly higher out-of-pocket expenses. It’s always best to aim for in-network providers if possible.

Step 3: Understanding Your Costs

Even with insurance coverage, you’ll likely have some financial responsibility. Understanding these costs upfront helps avoid surprises.

• Copayments (Copays): A fixed amount you pay for a covered healthcare service after you’ve paid your deductible. For example, you might have a $25 copay for an outpatient therapy session.
• Deductibles: This is the amount you must pay out of your own pocket for covered services before your CareSource plan begins to pay. For instance, if your deductible is $1,000, you’ll pay the first $1,000 of your treatment costs before your insurance starts contributing.
• Coinsurance: Once you’ve met your deductible, coinsurance is the percentage of the cost of a covered service you’re responsible for. If your plan has 20% coinsurance, and CareSource covers 80% (like a Gold plan), you’ll pay the remaining 20%.
• Out-of-Pocket Maximum: This is the most you’ll have to pay for covered services in a plan year. Once you reach this limit, CareSource pays 100% of the cost of covered benefits for the rest of the year. This provides a financial safety net.

It’s worth reiterating that for individuals with CareSource Medicaid plans in certain states, addiction treatment may come with $0 cost, meaning you might not have any copays, deductibles, or coinsurance for covered services. This is a huge benefit and makes treatment incredibly accessible. Always verify these details with CareSource or our advisors at (844) 491-5566.

Frequently Asked Questions about CareSource Coverage

We hear a lot of common questions about CareSource coverage for addiction treatment. Here are some of the most frequent inquiries we receive, along with clear answers to help you steer your options.

Does CareSource cover medications for addiction treatment like Suboxone?

Yes, generally, CareSource plans do cover medications for addiction treatment, such as Suboxone (buprenorphine/naloxone), methadone, and naltrexone. These are often referred to as Medication-Assisted Treatment (MAT), which is recognized as an evidence-based approach to treating opioid use disorder and alcohol use disorder. Since mental health and substance use disorder services, including MAT, are considered essential health benefits under the Affordable Care Act, CareSource plans are mandated to provide coverage.

However, the specifics of coverage can vary based on your individual plan, the state you’re in, and the particular medication. There might be requirements for pre-authorization, specific dosage limits, or a preference for generic versions over brand names. A medical professional will determine if MAT is appropriate for your treatment plan, and then you can work with your provider and CareSource to ensure coverage.

What if I need treatment but my CareSource plan is from a different state?

This is a very important question, as healthcare coverage is often state-specific. Generally, if your CareSource plan is from one state (e.g., an Ohio Medicaid plan), your coverage will primarily be for providers and services within that state. While some emergency services might be covered out-of-state, routine or planned addiction treatment usually requires you to seek care in the state where your plan is active and where CareSource operates its network for your specific plan type.

If you’ve moved or need treatment outside of your plan’s state, you might need to look into transferring your plan or obtaining new coverage in your current state of residence. This can be a complex process, but ensure your treatment is covered. For personalized guidance on navigating state-specific coverage and finding appropriate care, you can always call our specialists at (844) 491-5566. We can help you understand your options and connect you with resources.

How do I get pre-authorization for rehab with CareSource?

Pre-authorization (sometimes called prior authorization or pre-certification) is a common requirement for many significant medical services, including addiction treatment programs like inpatient rehab or even certain outpatient levels of care. It means that CareSource needs to approve the treatment before you start receiving it for the services to be covered. This process ensures that the proposed treatment is medically necessary and meets CareSource’s clinical guidelines.

Typically, you won’t need to handle the pre-authorization process yourself. Your doctor or the treatment facility you plan to attend will usually manage this. They will submit a request to CareSource that includes:

• Clinical documentation: This will outline your diagnosis, medical history, and the rationale for the specific level of care being requested (e.g., why inpatient detox is necessary over outpatient).
• Proposed treatment plan: Details about the type of therapy, duration, and services you will receive.

It’s crucial that this pre-authorization is obtained before you begin treatment. If you start treatment without the necessary approval, CareSource may deny coverage, leaving you responsible for the full cost. Always confirm with the treatment facility that pre-authorization has been secured before admission.

Start Your Recovery Journey Today

Addiction is a treatable disease, and with the right support, recovery is absolutely possible. We understand that taking the first step can be incredibly challenging, especially when you’re trying to figure out the complexities of insurance coverage. However, your CareSource plan provides a clear pathway to accessing the care you need and deserve.

At SoberSteps.org, we believe in empowering individuals with the knowledge and resources to make informed decisions about their health. We provide confidential and anonymous help for mental health and substance use disorders, connecting you to the right treatment options without judgment.

Do not let worries about insurance or uncertainty about treatment options keep you from seeking help. The commitment of CareSource to covering essential health benefits, including comprehensive addiction treatment, means that financial barriers are often significantly reduced or eliminated. Your well-being is our priority, and we are here to support you every step of the way.

Call our 24/7 confidential helpline at (844) 491-5566 to speak with a treatment advisor who can verify your CareSource coverage and help you start your recovery journey today.

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